Myocardial infarction

Physiology

Pathophysiology and Aetiology

Diagnosis

Clinical picture - signs and symptoms

ECG

Cardiac enzymes

GTN

Management

Rest

Cardiac monitor

Treat arrhythmias as they arise - eg ventricular fibrillation

Aspirin 300 mg dispersible stat

Establish venous access - do not keep open with an infusion

Analgesia iv. - diamorphine 5 mg/ morphine sulphate 10 mg with maxalon 10 mg

No intramuscular injections - thrombolysis and muscle enzymes

Oxygen

12 lead ECG

Psychological care

Observe for trends in observations

T

P

R

BP

Assess and record history - particular reference to pain history

Ask about allergies

Inform relatives/significant others

Arrange supervised transport to a CCU - minutes are muscle

Consider thrombolysis

What is the history of the pain

Streptoknioase - 1.5 million units over 1 hour in 200 mls infusion

Contraindications to thrombolysis

History of CVA

History of peptic ulceration

Systolic BP must be 100 - 200

Previous administration of Streptokinase

Clotting disorders

Recent surgery or bleeding injury

No streptokinase between 3 days to 1 year - if so use TPA

Complications of thrombolysis

Arrythmias

Hypotension

Bleeds

Observations for complications of MI

Arrhythmias

Heart block

Left ventricular failure

Cardiogenic shock